Between unresolved family conflicts, relationship struggles and his mixed-race identity, James Puckett had enough on his mind in college that he sought professional help. But after bouncing from one therapist to another, he still felt stuck.
"They were all female, and they did give me some comfort," said Puckett, 30, who works for a domestic-abuse program in Wisconsin. "But I was getting the same rhetoric about changing my behavior without any challenge to see the bigger picture of what was behind these very male coping reactions, like putting your hand through a wall."
He decided to seek out a male therapist instead and found that there were few of them. "I'm just glad I ended up with the person I did," said Puckett, who is no longer in therapy, "because for me it made all the difference."
Researchers began tracking the "feminization" of mental health care more than a generation ago, when women started to outnumber men in fields like psychology and counseling.
Today, the takeover is almost complete.
Men earn only one in five of all master's degrees awarded in psychology, down from half in the 1970s. They account for less than 10 percent of social workers under the age of 34, according to a recent survey. And their numbers have dwindled among professional counselors — to 10 percent of the American Counseling Association's membership today from 30 percent in 1982 — and appear to be declining among marriage and family therapists.
Some college psychology programs cannot even attract male applicants, much less students. At many therapists' conferences, attendees with salt-and-pepper beards wander the hallways as lonely as peaceniks at a gun fair.
The result, many therapists argue, is that the profession is at risk of losing its appeal for a large group of sufferers — most of them men — who would like to receive therapy but prefer to start with a male therapist.
"There's a way in which a guy grows up that he knows some things that women don't know, and vice versa," said David Moultrup, a psychotherapist in Belmont, Mass. "But that male viewpoint has been so devalued in the course of empowering little girls for the past 40 or 50 years that it is now all but lost in talk therapy. Society needs to have the choice, and the choice is being taken away."
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The reasons for the shift are economic as well as cultural, most people in these professions agree. Managed care took a bite out of therapists' incomes in the 1990s. Psychiatry, the most male-dominated corner of therapy, increasingly turned to drug treatments. And as women entered the work force in greater numbers, they proved to be more drawn to the talking cure than men — in giving the treatment as well as in receiving it.
Therapists often caution students against assuming that they have special insight into person's problems just because they have something in common. Perception, however, is all important when it comes to seeking help for the very first time.
In a recent study among 266 college men, Ronald F. Levant, a psychologist at the University of Akron, found that a man's willingness to seek therapy was directly related to how strongly he agreed with traditionally male assumptions, like "I can usually handle whatever comes my way." Such a man could be discouraged by the prospect of talking to a woman.
"Many men like this believe that only another man can help them, and it doesn't matter whether that's true or not," Levant said. "What's important is what the client believes."
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Both male therapists and men who have been in treatment agree that there are certain topics that — at least initially, all things being equal — are best discussed within gender. Sex is one, they say. And some men are far less ashamed about affairs when speaking to another man.
Aggression is another. Many men grow up in a world of hostile body language and real physical violence that is almost entirely invisible to women. A bar fight that sounds traumatic to a female therapist may be no more than a good night out for a man. Likewise, a stare-down in the sandbox that looks vanishingly trivial from a distance may lie like a poisoned well in the stream of the unconscious.
In just the past few years, psychologists have identified a number of issues that are, in effect, male versions of the gender-identity issues that so many mothers face in the work force: the self-doubt of being a stay-at-home father, the tension between being a provider and being a father, even male postpartum depression.
"In the same way that there is something very personal about being a mother, something very important to female identity, the experience of fathering is also very powerful," said Aaron Rochlen, a psychologist at the University of Texas in Austin. "And some men, I think, prefer to talk about that — the joy of being a father, the stress, how it's impacting them — with a therapist who's had the same experience," from the same point of view.